As Internet access becomes increasingly widespread, so do related psychopathologies such as Internet addiction and delusions related to the technology and to virtual relationships. Computer communications such as Facebook and chat groups are an important part of this story, says Dr. Uri Nitzan of Tel Aviv University's Sackler Faculty of Medicine and the Shalvata Mental Health Care Center in a new paper published in the Israel Journal of Psychiatry and Related Sciences.

In his study, the researcher presented three in-depth case studies linking psychotic episodes to Internet communications from his own practice. According to Dr. Nitzan, patients shared some crucial characteristics, including loneliness or vulnerability due to the loss of or separation from a loved one, relative inexperience with technology, and no prior history of psychosis or substance abuse. In each case, a connection was found between the gradual development and exacerbation of psychotic symptoms, including delusions, anxiety, confusion, and intensified use of computer communications.

The good news is that all of the patients, who willingly sought out treatment on their own, were able to make a full recovery with proper treatment and care, Dr. Nitzan says.

Behind the screen

The Internet is a free and liberal space that many individuals use on a daily basis and a growing part of a normal social life. But while technologies such as Facebook have numerous advantages, some patients are harmed by these social networking sites, which can attract those who are lonely or vulnerable in their day-to-day lives or act as a platform for cyber-bullying and other predatory behavior.

All three of Dr. Nitzan's patients sought refuge from a lonely situation and found solace in intense virtual relationships. Although these relationships were positive at first, they eventually led to feelings of hurt, betrayal, and invasion of privacy, reports Dr. Nitzan. "All of the patients developed psychotic symptoms related to the situation, including delusions regarding the person behind the screen and their connection through the computer," he says. Two patients began to feel vulnerable as a result of sharing private information, and one even experienced tactile hallucinations, believing that the person beyond the screen was physically touching her.

Some of the problematic features of the Internet relate to issues of geographical and spatial distortion, the absence of non-verbal cues, and the tendency to idealize the person with whom someone is communicating, becoming intimate without ever meeting face-to-face. All of these factors can contribute to a patient's break with reality, and the development of a psychotic state.

A changing social landscape

Dr. Nitzan and his colleagues plan to do more in-depth research on Facebook, studying the features and applications that have the potential to harm patients emotionally or permit patients to cause emotional harm to others. Some psychotic patients use the Internet to disturb people, abusing their ability to interact anonymously, he says.

Because social media are now such an important part of our culture, mental health professionals should not overlook their influence when speaking to patients, Dr. Nitzan counsels. "When you ask somebody about their social life, it's very sensible to ask about Facebook and social networking habits, as well as Internet use. How people conduct themselves on the Internet is quite important to psychiatrists, who shouldn't ignore this dimension of their patients' behavior patterns."